The greatest challenge in Asian LASIK is dealing with the smaller lid fissures and the smaller horizontal white to white, also look out for the patients with deep sockets, and loose conjunctiva, they can be very difficult to perform LASIK in. Apart from the obvious patient with short vertical interpalpebral distances that one often has problem placing the keratome, pay particular attention to the patient who is of small stature; there can be significant difficulty in placing keratome ring onto the smaller eye fissures. A special lid speculum designed specifically for Asian eyes is recommended. The smaller loop occupies less space thus allowing more room for the ring to fit. A pair of strong rigid arms, a locking mechanism and slightly pliable wire loops is ideal for the small palpebral fissures, the small loops create a diamond shaped fissure which is best for fitting a keratome ring onto the eye. The patient is examined paying particular attention to lid fissure distance both horizontal and vertical looking for loose conjunctiva and deep socket. Patient is warned that surgery may be difficult and a canthotomy may be necessary, offer alternative surgery such as LASEK or epi-LASIK should suction fail, patient must be mentally prepared before surgery.